Mississippi has fewer primary care physicians per capita than any other state, with one primary care physician for every 1,463 citizens. / Jose Elias/iStockphoto, Getty Images Thinkstock

by Jerry Mitchell, The (Jackson, Miss.) Clarion-Ledger

by Jerry Mitchell, The (Jackson, Miss.) Clarion-Ledger

JACKSON, Miss. -- In the land of the poorest poor, less than half of Mississippi's primary care physicians are willing to see new Medicaid patients.

In contrast, nationally more than two-thirds of doctors open their doors to new Medicaid patients.

"Everything else is moot if you can't get to a primary care physician," said Mississippi State University social science professor Ronald Cossman, who along with others conducted a study of health care access in the Magnolia State.

There are more than 5,000 doctors in Mississippi. Of those, 1,475 are primary care physicians, according to the Robert Grantham Center. There are even fewer offices, 678, according to the MSU study.

Mississippi has fewer primary care physicians per capita than any other state, with one primary care physician for every 1,463 citizens.

But even the presence of these physicians doesn't guarantee access, Cossman said.

He and other researchers had people pose as patients and telephone for appointments.

Among core primary care physicians, 47 percent agreed to take new Medicaid patients.

In contrast, new patients with private insurance got appointments three-fourths of the time, the study found.

Cossman said he expected a difference, "but I didn't realize the numbers would come up as they did."

Inability to get treatment can lead to more problems, he said. "If I've got a Medicaid card, I simply postpone what I've got. Then I wind up back at the ER, just like I didn't have insurance, but I'm still clogging the ER."

As a result, patients with diseases such as diabetes can wind up in worse shape, he said. "They can't get care and can't get preventative care."

Cossman estimated that between 20 percent and 30 percent of patients that Mississippi primary care doctors see are on Medicare or Medicaid.

The higher this percentage, the more difficult it is for these physicians to make money, he said.

The public needs to start thinking of doctors as business owners, Cossman said.

"They're just like an attorney or a CPA," he said.

Low reimbursement rates and administrative burdens play roles in the high rejection of Medicaid patients, he said.

There's also the matter of time, he said. "A doctor's office may have to wait 90 days for Medicaid and Medicare to get reimbursed."

Dr. Aaron Shirley, chairman of the Jackson Medical Mall, said the government's reimbursement rate for Medicaid cases is "terribly low. Sometimes it's less than cost."

A routine visit to a primary care physician might run $110 for the average patient, he said. "Medicaid reimbursement for that same visit would be more like $70 or $75."

In contrast, a federally qualified health center would get $110, he said.

In Mississippi, two private insurance companies, Magnolia and UnitedHealthcare, now cover Medicaid patients. If patients fail to pick one, Medicaid picks for them.

Dr. Luke Lampton, chairman of the state Board of Health, said most Mississippians think the difficulty with access to health care in our state is "a thing of the past. It's not."

Hospitals and small medical practices "must be helped," he said, "because in no uncertain terms they are our front line in access to care in rural areas. If they close, there is no access."

Dr. Robert Smith of Jackson, a family doctor who began pushing for the end of unequal treatment of patients a half century ago, said there is a real shortage of primary care physicians in parts of Mississippi, where more than a third of the state has been declared "medically underserved."

To help bridge that gap, lawmakers in 2007 authorized funding for the Mississippi Rural Physicians Scholarship Program, which identifies rural college students interested in returning home to practice medicine.

Last year, the program saw its first two graduates from the University of Mississippi Medical Center, one now working in the Delta and the other in an impoverished area in Jones County.

By 2016, the program expects to have 21 new primary care physicians in these rural areas.

According to the Robert Graham Center, Mississippi will need 364 more primary care physicians by 2030.